Detection of internal mammary lymph node metastasis with 18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with stage III breast cancer

Purpose The present study assessed the positive predictive value (PPV) of F-18-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for the detection of internal mammary node (IMN) metastasis in patients with clinical stage III breast cancer. Methods Patients who were diagnosed with clinical stage III breast cancer and underwent pretreatment F-18-FDG PET/CT were retrospectively analyzed. The F-18-FDG PET/CT scans were prospectively reviewed by two board-certified nuclear medicine physicians in a blinded manner. The intensities of IMNs were graded into four categories (no activity and lower, similar, and higher activities than that of the mediastinal blood pool). IMNs were measured from the combined CT (largest diameter of the short axis). Histologic data of the IMNs were obtained by ultrasonography-guided fine-needle aspiration biopsy or surgical excision. The PPV was calculated for pathologically confirmed IMNs. Visual grade, maximum standardized uptake values (SUVmax), and sizes were analyzed according to the pathology results. Results There were 249 clinical stage III breast cancer patients (age 48.0 +/- 10.1 years, range 26-79 years) who had undergone initial F-18-FDG PET/CT prior to treatment. Excluding 33 cases of stage IV breast cancer, 62 of 216 patients had visible IMNs on F-18-FDG PET/CT, and histologic confirmation was obtained in 31 patients. There were 27 metastatic and four nonmetastatic nodes (PPV 87.1 %). Metastatic nodes mostly presented with visual grade 3 (83.9 %), and SUVmax and size were 3.5 +/- 4.3 and 5.6 +/- 2.0 mm, respectively. Conclusion F-18-FDG PET/CT has a high PPV for IMN metastasis in clinical stage III breast cancer, indicating the possibility of metastasis in IMNs with FDG uptake similar to/lower than that of the blood pool or small-sized nodes.